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Welcome to Bonneygrove Primary School. Our school will reopen on Tuesday 3rd September 2024.
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Federation Bonneygrove Primary School and Millbrook Primary School - September 2024
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Asthma Documents
Supporting Children with Medical Needs Form
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Medication Asthma
Medication Asthma
Before completing this form you must agree that all medication given by the staff at Bonneygrove Primary School is done so with 'loco parentis responsibility'. Please indicate you agree by clicking the box below.
*
Yes I agree.
Child's First Name
*
Child's Surname
*
Child's Date of Birth
*
Full Address
*
Postal Code
Contact Telephone Number (Home or Mobile)
GP Name
*
GP Address
GP Postal Code
GP Telephone Number
When was your child diagnosed with Asthma ? E.g. 10/05/2023
*
Is your child's asthma - please select one.
*
Mild
Moderate
Severe
Does your child have disrupted sleep due to his/her asthma? PLEASE SELECT ONE.
Rarely
Occasionally
Frequently
How many times (if any) has your child attended the accident and emergency (A&E) department with an acute asthma attack in the past year?
Never
Once
More than One
If more than once please advise when .
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Who monitors your child's asthma?
Parent/Carer
Local Nurse
Local GP
Hospital
If the hospital monitors your child - please give the name and address of the hospital and the consultant.
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How often is your child seen by the Hospita/ GP/ Nurse?
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Only when he/she has had an asthma attack
On a 3-6 monthly basis
Annual check by the GP
What inhalers / medications has your child been prescribed?
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Reliever
Preventer
Other
Please advise the name of the Reliever / Preventer or Other
*
Can the family GP be contacted should we need additional information?
*
Yes
No
Name of Reliever / Inhaler or both.
*
Frequency of Use?
*
Does your child need their reliever/ inhaler before PE?
Yes
No
How many pumps do they need?
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One
Two
Three
Four
Five
Six
Does your child need support taking their inhaler?
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Yes
No
Does your child have a clear understanding on how to use their inhaler?
*
Yes
No
Does your child require a spacer for their inhaler?
*
Yes
No
In the event of my displaying symptoms of asthma, and if their inhaler is not available or unavailable, I consent for my child to receive salbutamol from an emergency inhaler held by the school for emergencies.
*
Yes
No
Additional Information you may want to share.
Does your child attend Kool KIdz?
*
Yes
No
Parent / Carer signature. By clicking 'yes' you agree to the terms of the asthma medical policy.
*
Yes
No
Submit
In this section
Medication Asthma
New Starter Form (On-Line)
Supporting Children with Medical Needs